Adherence to the EAT-Lancet diet, plasma proteomics and the risk of chronic obstructive pulmonary disease

Adhering to the EAT-Lancet diet has been observed to be associated with lower risks of various morbidities. This study aimed to investigate the association of adhering to the EAT-Lancet diet with incident chronic obstructive pulmonary disease (COPD) and identify plasma proteins mediating such association. This prospective study involved 202 340 participants free of COPD at baseline from the UK Biobank. Adherence to the EAT-Lancet diet was assessed by four different diet indices. Mediation effects of plasma proteins were investigated in a subcohort of 21 186 participants with information on plasma proteins measured by the OLINK Explore-3072 platform. Compared with individuals with the lowest adherence to the EAT-Lancet diet, those with higher adherence had a lower risk of developing COPD, and the HRs (95% CIs) for the highest adherence group versus the lowest were 0.607 (0.558 to 0.660) for the Willett EAT-Lancet index, 0.666 (0.593 to 0.748) for the Knuppel EAT-Lancet index, 0.586 (0.513 to 0.668) for the Stubbendorff EAT-Lancet index and 0.674 (0.620 to 0.732) for the Kesse-Guyot EAT-Lancet index. A total of 534, 149, 486 and 489 proteins showed significant mediation effects between the Willett, Knuppel, Stubbendorff or Kesse-Guyot EAT-Lancet index and incident COPD. The overall proteomic scores mediated 34.43% (95% CI: 22.86% to 53.45%), 24.15% (13.20% to 72.99%), 22.96% (14.53% to 41.13%) and 34.63% (21.26% to 60.38%) of the associations between the Willett, Knuppel, Stubbendorff or Kesse-Guyot EAT-Lancet index and incident COPD. Higher adherence to the EAT-Lancet diet was associated with a lower risk of COPD, and a wide range of circulating plasma proteins mediated such association.